Graduate Medical Education AY 2012 Annual Report · 2019. 12. 16. · Graduate Medical Education AY 2012 Annual Report Submitted from Division of Education Office of Graduate Medical

Graduate Medical Education AY 2012 Annual Report

Submitted from Division of Education Office of Graduate Medical Education December 20, 2012 by: William Bond, MD, MS ACGME Designated Institutional Official Jennifer McCormick, MBA Director, Medical Education Development Kimberly Cornwell, C-TAGME Graduate Medical Education Specialist

2012 Annual GME Report Page 2 of 21

Table of Contents Table of Contents………………………………………………………………………….2

Introduction……..…………………………………………………………………………3

GME Stats and Trends 2010-2012 ...................................................................................... 4

Improvements in GME .................................................................................................... 5-7

Summary and Schedule of Program Reviews…………………………………………….8

Match Summary………………………………………………………………………......9

Resident Involvement in Patient Safety and Quality ........................................................ 10

Resident Scholarly Work……………………………………………………………... ..11

Resident Performance on Core Measures………………………………………………..12

Central Lines Course Update…………………………………………………………13-14

Planned Growth ................................................................................................................ 15

Finance .............................................................................................................................. 16

Faculty Development…………………………………………………………………….17

AY 2013 Priorities ............................................................................................................ 18

Policy Update……………………………………………………………………………19

Appendix: AGCME Satisfaction Survey………………………………………………..20

Appendix: A3: Achieving and Documenting Procedural Competency at LVHN………21


Introduction This report covers academic year 2012 ending in June 2012. The Graduate Medical Education

community at Lehigh Valley Health Network continues to develop and implement policies and

learning strategies that achieve accreditation requirements and that prepare our resident

physicians to serve the Lehigh Valley community and beyond. The Graduate Medical Education

Committee (GMEC) and the Division of Education provides the institutional oversight required

to achieve these ends.

GMEC Mission – to offer graduate medical education programs in which physicians in training

develop personal, clinical, and professional competence under the guidance and supervision of

the faculty and staff.

GMEC Vision –to develop the strategies and mechanisms needed to ensure that LVHN’s

graduate medical education programs have adequate educational, financial, and human resources

to demonstrate measurable improvements in learning and patient outcomes.

GMEC Strategy – GMEC’s strategy is based on organizational objectives and the Accreditation

Council for Graduate Medical Education (ACGME)’s definition of “institutional competency,”

which includes an organization’s ability to:

Gather and analyze data from the educational and clinical environments.

Ensure resident education in patient safety and quality of care.

Lead program and academic innovations.

Predict and trend performance.

Develop, align and implement policies and procedures that impact graduate medical

education programs.

Create conditions that promote collaboration and knowledge sharing and transfer. We are pleased to provide the following 2012 Graduate Medical Education report highlighting

evidence of ongoing strengths, opportunities and the larger trends affecting Lehigh Valley Health

Network’s Graduate Medical Education programs.


Overview: Academic Years 2010-2012

GME Demographics AY10 AY11 AY12 HIGHLIGHTS

# residents/fellows 206 215 222 off cycles, comp incr, new prgm

# visiting residents 83 73 78 Hershey's OB/Anes

# total accredited residency programs 14 15 17 1st year for Peds/HPM

# allopathic (ACGME) accredited programs 10 10 12

# osteopathic (AOA) accredited programs 4 5 5

# dually (ACGME/AOA) accredited programs 2 2 2

# re-accredited programs 1 2 5 Institutional, EMRES(x2),

OBGYN, Osteo Intern,

# new program(s) applied for 2 3 2 Hem Onc/Nephr

# of graduates 77 81 87

Resident Recruitment and Match Data

# U.S. medical school applicants 1462 1782 2360

# applicant interviews conducted 631 658 879

# match positions available 77 79 91 Neph, Peds, HPM, Incr

% from allopathic accredited medical schools 45% 49% 50%

% from osteopathic medical schools 39% 35% 33%

% from international medical schools 16% 16% 17%

% from Pennsylvania medical schools 37% 30% 33%

Program Development

# internal reviews conducted 3 4 3 Dental, Derm, Plastics

# progress reports reviewed and approved 4 2 3 EMRES, Peds, Plastics

Resident satisfaction survey (LVHN internal survey)

Participation rate 72% 92% 74%

Overall satisfaction (1=poor, 5=excellent) 4.14 4.03 4.2

Resident satisfaction survey (ACGME)

Participation rate 90% (appx for full reports) 92% 94% 90%

GME policies reviewed and updated 5 20 7 .

# residents contributing to publications 51 28 30

# residents contributing to poster presentations 38 53 15

% senior residents participating in QI 97% 100% 100%

Faculty Development (DOE provided)

# faculty development workshops offered 30 78 40 # attendees 389 401 239

# resident as teacher workshops offered 5 12 13

# attendees 46 273 291


Improvements in GME

Resident Evaluation

GMEC has developed and implemented a policy to ensure timely feedback of residents. The

goal is that faculty members complete 75% of their evaluations assigned to them within 30

days of a resident’s completion of a rotation. In AY12, 85% of all faculty members who

were assigned an evaluation met the goal within 30 days.

Resident Duty Hours Tracking:

GMEC elected in AY12 to track the directive that residents “should have 10 hours off between

clinical duties” with awareness that the regulations state “must have 8 hours off.” The process for

duty hours tracking worked well in AY12 and no cases were referred to the DIO/Disciplinary

Action Review Committee. The unweighted average compliance with logging duty hours was

89% and resident signoff was 90%. Many of the duty hours violations had explanations in the

comments such as “stayed for interesting OR case,” which is allowed by AGGME rules.

AY12 ACGME Rule Compliance – Snapshot

Department 80 HR Call Off NF 24+ SB – 10 SB – 8

Cardiology Fellowship 1

Colon/Rectal Surgery 1 2 5

Dermatology

Emergency Medicine 10 5 4

Family Medicine 7 34 14

General Surgery 3 13 3 13 6

Hospice/Palliative Medicine

Internal Medicine 3 8 3 48 2

Transitional Year

Obstetrics/Gynecology

Plastic Surgery

Surgical Critical Care

SB = short break

Recruiting Efforts:

In April 2012, LVHN offered a multispecialty recruiting effort at a hotel next to the Philadelphia

College of Osteopathic Medicine. We believe pre-publication efforts by email may not have

been forwarded on to several of the medical school students thus leading to poor turnout. Those

who did attend enjoyed the experience and had very positive interactions with LVHN faculty.


After further analysis, we have decided to shift future central recruiting efforts to improvement

of the website. Each residency is really targeting different sets of applicants due to their relative

competitiveness in their field. Each residency will continue to conduct the in person recruiting

activities it feels are most appropriate. The increased numbers of graduating medical students,

combined with a fixed or only slightly enlarging residency slot number nationally should lead to

more competitive applicants without any effort on our part. This year we had 1861 applicants

for all programs combined and hosted 896 interviews.

Common GME Curricula:

Resident Orientation 2012 well received:

Resident orientation meets many needs with regard to common program requirements. This

year’s common orientation included the standard HR orientation for all employees, additional

talks on professionalism, and a day-long seminar that covered the following topics:

Orientation Session (Instructor Led) Overall Satisfaction

(5 point scale)

Crucial Conversations conflict resolution (4 hour workshop) 4.3

Stress Reactivity (1 hour) 4.3

Sleep and Fatigue (1 hour) 4.6

TeamSTEPPS® (1 hour introduction) 4.6

Cultural Competency and Interpreter Services (1 hour) 4.4

IHI Open School Modules:

LVHN purchased a subscription to the IHI Open School online modules that include patient

safety and quality. Those modules were made available to the residents in spring and some

residencies are specifically assigning courses for FY13. These modules are hosted in an outside

learning management system and we anticipate reporting resident usage statistics for next year.

Data Repository Project:

As of October 2012, the repository of scholarly works was in the process of launching.

Preliminary work looks promising and there will be more to follow in next year’s report.

Support for Research in GME:

The Network Office of Research and Innovation has developed open weekly office hours for

statistical support of research projects. This came late in FY12 and the impact should become

apparent in FY13.


Cultural Competency Education

In FY12, all LVHN employees, including residents completed an on-line cultural competency

program, “Exploring Cultural Awareness.” The purpose of this brief program is to ensure that

LVHN employees understand the definition, rationale and resources available to them to provide

effective cross-cultural communication and health care.

In addition, during AY12, three LVHN clinical departments requested cultural awareness

education sessions that were available for residents. Judy Sabino, diversity/cultural awareness

liaison, conducted two sessions in Family Medicine (Grand Rounds in July and a learning lab for

PGY1 residents in November), two sessions in Medicine (a Quality Improvement Forum in

December and Grand Rounds in April) and an introductory session for the Palliative Medicine

fellow in January.

In June 2012, Jarret Patton, MD and Judy Sabino provided a session on cross-cultural health care

during resident orientation. Over 80 new residents participated in this session that defined

culture and its impact on health illness as well as demonstrated a patient-based approach to cross

cultural health care.

A SELECT medical student conducted an informal assessment of cultural awareness education

in selected LVHN residency programs during his summer immersion project in June. While the

five residency programs reviewed are aware of and committed to cross cultural care; variation

exists in the approach and time given to this subject. This topic is under consideration by GMEC

as a common GME topic for either education or standardized assessments.

Resident Baseline Assessment

Baseline assessment is a competency based assessment to assess residents’ level of attitudes and

skills in communicating with patients, families and colleagues. Residents from the following

residencies participated: Dental Medicine (7), Family Medicine (5), Emergency Medicine (14),

Obstetrics & Gynecology (5), Surgery (5), and Dermatology (2). Standardized Patients were

trained to portray the patient or family member in 3 separate scenarios. The Standardized Patient

completed a checklist on the intern's performance. Each station was also recorded. This year we

placed the checklists online and provided the standardized patients and residents iPads to

complete the checklists. The overall rating by residents 3.43 out of 4 = excellent 3 = good

Comments regarding the overall experience:

Great learning experience

A very good opportunity to practice communication skills.

This exercise was great because I got the chance to practice scenarios I haven't encounter

before working with a real life scenario at the hospital.

I look forward to having more simulation experiences because these have been very

enlightening.


Summary and Schedule of Program Reviews

Going forward as we move into the Next Accreditation System (NAS) of the ACGME programs

will be evaluated every 10 years with a site visit. Early site visits can occur sooner based on

annual data being submitted by the programs. The institution will have Clinical Learning

Environment Review (CLER) data submission and site visits every 18 months.

Accredited Programs Status Effective Date Next Site

Visit Date

Cycle

Length

Internal

Review

Timeline

# Citations

Colon/Rectal Surgery Continued

Accreditation 09/21/2012 09/01/2016 4 09/11/2014 2

Emergency Medicine Continued

Accreditation 02/10/2012 02/01/2022 10 02/01/2017 5

Family Medicine Continued

Accreditation 10/10/2012 10/01/2014 2 10/07/2013 6

Internal Medicine Continued

Accreditation 10/01/2006 10/01/2015 NAS 11/01/2013 3

Cardiology Continued

Accreditation 05/15/2010 10/01/2015 NAS 01/01/2013 1

Nephrology Initial

Accreditation 07/01/2012 07/01/2015 3 08/12/2013 0

Hematology/Oncology Initial

Accreditation 07/01/2012 07/01/2015 3 12/09/2013 0

OBGYN Continued

Accreditation 10/13/2011 10/01/2016 5 04/07/2014 0

Pediatrics Initial

Accreditation 07/01/2011 03/01/2014 3 09/12/2012 4

Plastic Surgery Continued

Accreditation 10/03/2008 10/01/2013 5 04/01/2013 0

Surgery Continued

Accreditation 11/01/2012 11/01/2017 5 04/01/2015 Pending

Surgical Critical Care Continued

Accreditation 11/01/2012 11/01/2017 5 04/01/2015 Pending

Hospice/Pall Med Initial

Accreditation 07/01/2011 05/01/2014 3 11/12/2012 0

Transitional year Continued

Accreditation 05/21/2008 05/01/2013 5 10/05/2010 1


Match Summary

2012 Match Summary

Combined Allopathic, Osteopathic & Sub Spec. Matches

74 match positions available (+10 outside the match, +7 Dental)

91 total filled positions

50% from U.S. Allopathic schools (includes Dental)

33% from U.S. Osteopathic schools

17% from International medical schools Allopathic Match (NRMP)

44 total positions available

44 filled

73% from U.S. Allopathic schools (0% students from University South Florida; 4% or 2 students

from Penn State College of Medicine)

9% from U.S. Osteopathic schools (4)

18% from international medical schools (8) Match from LCME Schools (All matches)

27% Non-PA based

33% PA-based

- Drexel University School of Medicine (5)

- Jefferson Medical College (4)

- Penn State College of Medicine (3)

- Temple University (5)

- University of Pennsylvania (1)

- PCOM (10) Match from Osteopathic Medical Schools (DO Match)

35% Non-PA based

65% PA-based

- Philadelphia College Osteopathic Medicine (7)

- Lake Erie College Osteopathic Med (6) LVHN Clerkship Rotations

32% of matching residents (n=28) did at least one clerkship at LVHN. These residents did a total of

48 rotations made up of third year clerkships and fourth year electives. £ - Notes currently enrolled in LVHN Residency (3)


Resident Involvement in Quality and Patient Safety Residents are encouraged to participate in the peer review process. Therefore, attending a peer

review committee meeting (M&M) for their department counts toward this goal. Peer review

committees discuss system factors, human factors, patient factors and medical decision making

in their deliberations. Residents may also be directly involved in performance improvement

projects. Such projects are typically interprofessional and often interdisciplinary. Network level

performance improvement projects give exposure to SPPI coaches. In addition, residents often

choose to write up their performance improvement projects at the abstract/poster level, some of

which go on to become peer reviewed publications.

Program

# Residents Performing

Case Review

# Residents Assigned

Case Review

% Residents

Completing Case

Review

Nature of Case

Review

# Senior Residents Participating in PI project

# Senior Resident

s

% of Residents

Completing a PI project

Dermatology

2 2 100


Charts vs. EBM 13 13 100

Internal Medicine 16 16 100 M&M 32 32 100

General Surgery 22 22 100 M&M

Plastic Surgery 4 4 100 M&M

Colon/Rectal Surgery 2 2 100 M&M

Surgical Critical Care 1 1 100 M&M 1 1 100

Ob/Gyn 20 20 100 M&M 5 5 100

Dental 7 7 100 Treatment planning


chronic pt chart rev 6 6 100

Cardiology 14 14 100

Structuredpeer chart

review 4 4 100

HPM*

Totals 104 104 59 59

*first year of fellowship and fellow began after start of AY


Resident Scholarly Work

Research expectations vary across the different residency review committees. LVHN residents

participate in various forms of scholarly activity including case studies, retrospective data

analysis, and occasionally prospective research. Residents are encouraged to be involved in the

various stages of investigation including hypothesis refinement, IRB submission, data collection,

data analysis, and abstract writing. Some residents are fortunate enough to present at academic

meetings in poster format, some present orally with slide shows, and through continued diligence

many go on to see their work in print as published manuscripts.

Program Research Abstracts

Resident Poster or Oral Presentations

Manuscripts Published

Pediatrics N/A N/A N/A

Dermatology 5 5 6


Internal Medicine 0 5 0

Transitional 0 0 0

General Surgery 9 9 3

Plastic Surgery 5 5 1

Colon/Rectal Surgery 6 6 0

Surgical Critical Care 0 0 0

Breast Surgery 1 1 0

Ob/Gyn 6 5 2

Dental 0 0 0


Cardiology 1 9 23

HPM 0 0 0

Totals 39 50 41


Resident Performance on Core Measures

Core measures were examined for patients with resident involvement and a principal diagnosis

of congestive heart failure and pneumonia. For example, in a case of heart failure, if the patient

has an ejection fraction of less 40 % (poor heart contractility), an ACE inhibitor or ARB class of

medication should be prescribed or a contraindication documented by the provider to ensure

compliance with the core measure. Likewise, patients with heart failure must have appropriately

documented discharge instructions.

Several challenges became apparent in reviewing this data set. First, defining the responsible

resident can be difficult, because the resident may be captured as the doctor on the admitting

history, the discharge summary, or for other care encounters. Residents also transfer the care of

patients multiple times during one patient’s stay. The fragmented nature of the electronic health

record at LVHN also contributes to the difficulty. In summary, the data were not considered

reliable enough for reporting purposes and we will continue to work to procure improved

resident quality data that can provide useful feedback to residents and program directors.


LVHN Central Venous Catheter Course Update

LVHN has developed an uptick in Central Line Associated Bloodstream infections. This uptick

is believed to be due to special cause variation that is likely related to the maintenance process

and long catheter dwell times. A multidisciplinary and interprofessional group is actively

working on process improvement in this area. The CVC course is one piece of maintaining both

mechanical and infectious safety for this procedure. The course has reached a point of

significant refinement and was well received as noted below.

Course Modifications for the June 2012 cohort:

Pre-training by watching videos in “Access Medicine” for tracking

Only one hour of lecture format for local protocols and process

Sterile procedure video and hands-on review

Hands-on practice time increased

An ultrasound station with more machine access and learning objectives checklist

Check-off run technical checklist directly entered into New Innovations resident tracking

system via iPads

Knowledge Test Performance


Technical Checklist Performance

Overall

Total resident participants 56

Total Passing 52

Total Needing Remediation 4

Total Possible Observable Actions 20

Mean Score 19.49 (97.45 percent)

Standard Deviation 0.64

Check-off run performance after training:

Post Course Evaluation Feedback:

Likert scale feedback (5 = agree, 3 = undecided, 1 = strongly disagree) for “would recommend

this activity to others” was 4.92. All residents either agreed or strongly agreed with that

statement. Representative comments follow:

Practicing the procedure. I learn best by actually doing it, so it was good to be able to

practice in small group settings then apply it by myself on the skills test portion.

I really had such a great experience with this course today. I was very nervous in my

abilities (still am a bit), but definitely feel more confident now that I've had this

opportunity. I am happy that the mannequins were left out at the end to continue to

practice. Pacing was great, and the groups were small enough that everybody got ample

time at each station.

The instructors were very helpful and through in explaining the procedures regarding

central line access and peripheral line access.

Outstanding experience!


Graduate Medical Education Planned Growth

AY12

(# of residents/fellows)

AY15

(# of residents/fellows)

Cardiology Fellowship 14 15

Colon/Rectal Surgery 2 2

Dental Medicine 7 7

Dermatology 6 6

Emergency Medicine* 57 56

Emergency Medicine Services Fellowship 1 1

Family Medicine* 19 18

General Surgery ^ 28 25

Hematology Oncology Fellowship (applying) 0 2

Internal Medicine 48 48

Nephrology 0 6

OB/GYN 20 20

Hospice and Palliative Care (approved) 1 2

Pediatrics 0 18

Plastic Surgery Residents (reflects change to

integrated program)^

3 6

Surgical Critical Care Fellowship 2 (off cycle resident) 1

Transitional Year 14 14

TOTALS 222 247

* Dually Accredited programs (allopathic and osteopathic)


GME Finance Update

Current residents relative to federally funded GME “slots”

Since 1965, Medicare has been reimbursing teaching hospitals for their training of doctors. In

1996, based on individual teaching hospitals’ cost reports, Medicare capped graduate medical

education reimbursements. LVHN currently trains more residents than the number of federally

funded “slots.”

In FY 11, LVHN requested 18.0 additional resident slots from CMS for the pediatrics residency

which begins AY13. LVHN also requested an additional 5.0 slots for the general surgery

program. Both were requested under section 5506 of the Affordable Care Act of Public Law

111-48: Preservation of FTE Capt Slots from Teaching Hospitals that close (slot reallocation).

During FY12 we found out that we did receive those slots, which is a significant benefit for

LVHN.

This year we plan to again apply for section 5506 redistribution slots under the criteria of “cap

relief.” We anticipate a very competitive field in this round.

Medical Education Funding (based on IME calculation)

Site CC and 17th

MHC

Total count of "allowable" resident FTEs 145 64

1996 Cap 113 3

Section 5506 Cap Adjustment 22 42

Total federally funded "slots" 135 45

Amount Above Cap* 10 19

*LVHN receives partial slot funding for an additional 41 slots under Section 422

Resident Salaries

PGY Level

2012 AAMC HSS Northeast Region 50th Percentile (Median)

FY13 LVHN Resident Base Salaries

PGY1 52,034 52,430

PGY2 54,435 55,089

PGY3 57,057 57,650

PGY4 59,395 60,738

PGY5 62,387 63,635

PGY6 & up 64,297 66,531


Faculty Development

Teaching Leader Series

With generous support from the Dorothy Rider Pool Health Care Trust, the Division of

Education sponsors and delivers network-wide interprofessional workshops for all clinical

educators (i.e. physicians, nurses, physician assistants, etc.) The Teaching Leader Series

provides great topics and speakers, information and skills to take network teaching to a new

level, and opportunities to collaborate with other educators throughout the Network. This year

the series hosted 243 participants over the course of 24 classes. Following each workshop

participants are asked to complete an evaluation of the session. The overall average result of this

series is reported below:

Workshops delivered content on diverse topics including:

Medical Intervention One Minute Preceptor

Patient Preference Presentation Skills

Quality of Life Professionalism Under Pressure

Contextual Features Remediation/Academic Support Skills

Ethics Autopsy Small Group Teaching

Curriculum Design Teaching and Learning Technology

Difficult Feedback Teaching at the Bedside

Direct Observation of Clinical Skills Teaching Cultural Awareness

Effective Patient Education The “Rime” Method of Assessment

0

1

2

3

4

5

The objectivesfor this activity

were met

The speakerskept meengaged

I learned newknoledge from

this activity

I will be able toapply what I

have learned tomy job

I wouldrecommend this

activity toothers

This activity willimprove my job

performanceand productivity


2013 Priorities

Next Accreditation System Next Accreditation System: In February 2012, the ACGME announced the “Next

Accreditation System” (NAS)2 that uses specialty specific competency milestones that will be

tracked via annual data collection from programs. This creates the opportunity for annual review

of performance metrics and is then supplemented with a site accreditation visit every 10 years

instead of the current 4 to 5 year cycle. The plan is to move away from detailed process

standards (hours of lecture time) toward more meaningful quantitative measures. These include

board pass rates, program attrition rates (changes in program director, faculty and residents),

benchmarked resident and faculty survey data, case log data, progress toward milestones and

summary data on scholarly output.

The Next Accreditation System (NAS) will be establishing milestone competencies in each

specialty over the coming years. They envision reporting of at least 30-36 data elements per

specialty program that would demonstrate achievement of the milestones. These metrics are to

be submitted every six months in parallel with the semiannual resident review with their program

director. This creates an unprecedented need to gather and report educational metrics. The

Office of GME is working with our Distance Learning team to assess the capabilities of New

Innovations to meet this need and share best practice across residencies.

Procedural Competency A3 The GMEC has on ongoing A3 in the area of procedural competency (see appendix). This A3 is

very much in keeping with the objectives of the NAS. The goal is to improve the process of

achieving and documenting procedural competency.


GME Policies Policies Revised or Approved during AY12

Graduate Training Agreement (Annual Review)

Work Environment

GME Responsibilities

Disaster

Moonlighting

Certificate of Invasive Procedures (new)

Professionalism Statement (new)

Policy Revisions Scheduled

Faculty Evaluation of Residents

GME Responsibilities

Graduate Training Agreement Appendix II, Schedules A,B,C.

(Resident Fair Hearing and Grievance policies)

Internal Review

Institutional Agreements

Loss of Lifebook

Moonlighting

Institution Means at-a-glance Residents' overall evaluation of the program

Institution Mean National Mean

Duty Hours% Compliant Mean National

80 hours 99% 4.8 4.81 day free in 7 98% 4.9 4.9In-house call every 3rd night 99% 5.0 5.0Night float no more than 6 nights 100% 5.0 5.08 hours between duty periods (differs by level of training) 96% 4.7 4.7Continuous hours scheduled (differs by level of training) 96% 4.8 4.8

Reasons for exceeding duty hours:Patient needs 5%Paperwork 7%Ed. Experience 2%

Cover other's work 1%Night float 2%Schedule conflict 2%Other 1%

Faculty% Compliant Mean National

Sufficient supervision 93% 4.3 4.4Appropriate supervision 96% 4.7 4.7Sufficient instruction 89% 4.2 4.2Faculty and staff interested 87% 4.3 4.3Faculty and staff create environment of inquiry 84% 4.2 4.2

Evaluation% Compliant Mean National

Access evaluations 99% 5.0 5.0Evaluate faculty 100% 5.0 5.0Evaluations of faculty confidential 85% 4.2 4.3Evaluate program 97% 4.9 4.9Evaluations of program confidential 87% 4.3 4.3Program uses evaluations to improve 74% 4.0 4.0Satisfied with feedback after assignments 73% 3.9 4.0

Educational Content% Compliant Mean National

Provided goals and objectives for assignments 99% 5.0 4.9Instructed to manage fatigue 97% 4.9 4.8Satisfied with scholarly activities 69% 3.9 4.1Appropriate balance for education 83% 4.2 4.2Education (not) compromised by service 73% 3.9 4.0Supervisors delegate appropriately 86% 4.1 4.2Given data to show personal clinical effectiveness 78% 4.1 3.6Variety of patients 97% 4.9 4.9

Resources% Compliant / % Yes* Mean National

Access to reference materials 99% 5.0 5.0Electronic medical record in hospital* 98% 4.9 4.6Electronic medical record in ambulatory* 96% 4.8 4.5Electronic medical records integrated* 80% 4.5 4.7Electronic medical record effective in daily clinical work 96% 4.1 4.1Way to transition care when fatigued 75% 4.0 4.2Satisfied with process to deal with problems and concerns 77% 4.0 4.2Education (not) compromised by other trainees 89% 4.4 4.5Residents can raise concerns without fear 78% 4.1 4.2

*Responses options are Yes or No. These responses are not included inthe Program Means and are not considered non-compliant responses.

Patient Safety% Compliant Mean National

Tell patients of respective role of residents 98% 4.6 4.5Culture reinforces patient safety responsibility 99% 4.5 4.5Participated in quality improvement 76% 4.0 4.0Information (not) lost during shift changes 93% 3.8 4.0

Teamwork% Compliant Mean National

Work in interprofessional teams 98% 4.7 4.6Effectively work in interprofessional teams 98% 4.3 4.4

© 2012 Accreditation Council for Graduate Medical Education (ACGME)

2011-2012 ACGME Resident Survey - page 1

410724 Lehigh Valley Health Network - Aggregated Program Data

Programs Surveyed

Residents Responded

Response Rate

9

183 / 203

90%

Survey taken: January 2012 - May 2012


cards - separate flow for cvc now that signoff required, using bedside paper cards for cvc signoff, inserted the med staff

privilege step of info flow (quarterly med staff update), summary log submitted quarterly and audited by pd, has MR numbers and is reviewed semi annually , final summary letter has numbers in prose statement includes procedures - use milestones for things like echo, levels of proficiency give certain privileges. Everything gets over-read dental

cosign of chart counts as the cosig monthly review by pds, monthly stats excel log transfer from paper OB

using a "competency tool" internal to their program and LVHN to help document competency (volume≠ competence) Much of it is not procedural, but competency in the broad sense and fits well with where NAS is heading -For bedside procedures some programs use New Innovations (NI) to document, some use paper, some use self logs acgme 14 things have mins like process, diff to implement derm

end of rotation eval , procedural skill level on that form and is summary of multiple procedures observed, all proc fully supervised, annual report by pd , number of procedures hand logged em

well evolved tracking mechanism, incorporated simulated runs using checklists, sets minimum bars, expectations for supervision, expectations for recheck of competency, logbooks for offservice get entered back into NI im

considering a separate compliance report for faculty sign off on procedures, reports of compliance with sign off go to division chiefs, core faculty and non-core get compliance reports, upper year resident or attending may be assigned as the supervisor, going back to NI for tracking

-document individual competence -document individual numbers of procedures -document programmatic numbers of procedures (benchmarking) -serves as MOC beginning point, and maybe even within residency (EM's yearly revisit) -give residents proof they need for future med staff privileges -feeds the med staff system that nurses or outsiders could check to verify status -security of MR numbers assoc with procedures must be maintained -standard checklists for the same procedure (more extensive checklists in education setting and/or competency check)

Unclear why NI is not used by many residencies and heavily used by others. Survey software has its limits (qualtrics tried) Computer / ipad / phone etc. method matters for data entry. App like approach would be great, but many different apps could be a nightmare to create, maintain, export from Is faculty sign off or faculty audit what is really needed? Probably checklist signoff for sim and competency check, but otherwise simple sign off or at a minimum audit capability. The step of posting to med staff services in some system that could be checked by a nurse or outside reviewer is lacking or not timely. Future systems should be flexible to adapt to the acgme’s growing tracking role either by export or audit Complications: resident self report may be lacking on complications and delayed complications are challenging to track/report Medical staff mainly looks at bulk data imports for incoming attendings, limited privileges for fellows, and tends to see privileges as a yes/no rather than state of evolving competency.

Title: Achieving and documenting procedural competency at LVHN

-increasing call for accountability from society funneling to ACGME -ACGME has logging mechanism for surgeries used by GS, OB, fellows -PDs can review the ACGME file and most do quarterly -To be primary surgeon they need to do 51% of the procedure, if not they don't get credit. -Most credentialling bodies rely on the PD, thus our LVHN residency records, to verify/vouch when they are getting privileges -The Next Accreditation system (NAS) will look at competencies and procedures (30-36 per residency, specialty specific) -big data collection needs coming, unclear if New Innovations (NI) will export to ACGME databases or not

Background

Current Conditions

Target/Goal(s)

Proposed Countermeasure(s)

Analysis

Plan

Followup

Ensure residents and coordinators are comfortable with the logging process in NI. Ensure login process to NI is seamless for faculty and residents Ensure that the process of signing off the first five (passing) then just logging is set up to reduce doc burden. “sign off” is either one radio button confirm pass, or an abbreviated checklist for the first five, not the long checklist of the sim lab after the first five logging, but not sign off (signoff can be required at PD / RRC discretion) work with new dL team member (TLH) on creating a first five sign-off that automatically rolls to the >5 the simple logging process within NI demonstrate that process at GMEC consider standardizing abbreviated checklists for the first five via GMEC member discussions clone the checklist process across procedures roll the process out across programs advocate for greater support of the sign off process among both core faculty and other medical staff who are credentialed in the procedure and thus able to sign off ( medexec support) side benefits of checklist discussions: Longer checklists can be available in NI for check off runs, delayed checks, and bedside use if desired.


Documents

Graduate Medical Education AY 2012 Annual Report · 2019. 12. 16. · Graduate Medical Education AY 2012 Annual Report Submitted from Division of Education Office of Graduate Medical